Dispute Resolution Services - Sample

THIS IS AN AGREEMENT TO MEDIATE

made on [Date]

BETWEEN 

AND

The parties hereby agree to mediate this grievance concerning file [File number].

By signing this document the parties undertake to conduct this mediation process in good faith and in a forthright manner, and to make a serious attempt to resolve the outstanding matters.  The parties wish to mediate these matters in accordance with the following terms:

1. [Name of mediator] has been appointed to act as mediator;
2. the parties agree that the mediator is a neutral facilitator who will assist the parties to reach their own settlement.  Further, the mediator has no duty to assert or protect the legal rights of any party, to raise any issue not raised by the parties themselves or to determine who should participate in the mediation;
3. the parties and/or their representatives attending the mediation will have the authority to reach a settlement in this matter, or will have the means to readily and rapidly obtain that authority;
4. all information exchanged during this entire procedure shall be divulged on a without prejudice basis for the purposes of settlement negotiations and shall be treated as confidential by the parties and their representatives subject to the requirements of any statute and the need to protect individuals against physical harm. Furthermore, evidence that is independently admissible or discoverable shall not be rendered inadmissible or non-discoverable by virtue of its use during the mediation;
5. it is understood that in order for mediation to work, open and honest communications are essential;
6. the parties undertake to communicate with each other in a civil and courteous manner;
7. it is recognized that the mediation process is voluntary, and may be terminated by the mediator or the parties at any time;
8. the mediator is free to caucus with the parties individually, as he or she sees fit, to improve the chances of a mediated settlement.  Any confidential information revealed to the mediator by one party during such caucusing may only be disclosed to the other party with the former party’s express permission.  It is understood that any of the parties may request at any time to caucus, with or without the mediator;
9. in order to ensure the confidentiality of the process it is understood that any notes prepared or written by the mediator shall be destroyed; the mediator shall only report to the Board whether there has been a full settlement or not; any memorandum of settlement reached by the parties shall not be placed on any Board file, nor shall its terms be disclosed unless the parties otherwise agree ;
10. it is agreed that when a settlement is reached there will be a written memorandum of settlement, which will be signed by the parties forthwith.

DATED AT [Location], on [date]

SIGNATURES: